Two new studies suggested that integrative therapies are worthy of investigation and may be effective in treating mental illnesses such as depression and bipolar disorder.

In one study, researchers from Emory University School of Medicine in Atlanta, Georgia explained that among the factors making recognition of severe depression problematic for clinicians are the heterogeneous nature of the condition, lack of standardized definitions and concomitant comorbidities that confound differential diagnosis of symptoms.

The study suggested that the chronicity and heterogeneity of this disorder lead to frequent clinic visits and a longer course of treatment; therefore, successful approaches may require an arsenal of treatments with numerous mechanisms of action.

Researchers reviewed the categories of drugs used to treat severe depression and several non-pharmacologic options including a number of experimental treatments. Pharmacotherapies included tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs), atypical antidepressants such as serotonin-norepinephrine reuptake inhibitors and monoamine oxidase inhibitors (MAOIs) and combination and augmentation therapies.

According to the study, the role of non-pharmacological treatments, such as electroconvulsive therapy, vagus nerve stimulation, transcranial magnetic stimulation and deep brain stimulation, remain active avenues of investigation.

Researchers concluded that improved knowledge and treatment approaches for severe depression are necessary to facilitate remission, the ideal treatment goal.

In another study, researchers from Xi'an Jiaotong University College of Medicine in China suggested that Chinese herbal medicines possess the therapeutic potential for mood disorders.

In a double-blind, randomized, placebo-controlled study, researchers evaluated the efficacy and side effects of the herbal medicine called Free and Easy Wanderer Plus (FEWP)® as an adjunct to carbamazepine (CBZ, a drug sometimes used as an alternative to lithium in stopping the symptoms of manic depression and is particularly effective in people with rapid swings between mania and depression) in patients with bipolar disorder.

Researchers randomized 124 bipolar depressed and 111 manic patients to treatment with CBZ alone, CBZ plus FEWP or equivalent placebo for 12 weeks. CBZ was initiated at 300 milligrams/day and FEWP was given at a fixed dose of 36 grams/day. Efficacy measures included the Hamilton Rating Scale for Depression, Montgomery-Asberg Depression Rating Scale, Young Mania Rating Scale, Bech-Rafaelsen Mania Scale and Clinical Global Impression-Severity (CGI-S).

The study found that CBZ monotherapy produced significantly greater improvement on manic measures at week two through endpoint and CGI-S of depression at endpoint compared to placebo. CBZ monotherapy also yielded significantly higher clinical response rates than placebo on bipolar depression (63.8 percent vs. 34.8 percent) and mania (87.8 percent vs. 57.1 percent).

Compared to CBZ monotherapy, adjunctive FEWP with CBZ resulted in significantly better outcomes on the three measures of depression at week four and week eight and significantly greater clinical response rate in depressed subjects (84.8 percent vs. 63.8 percent), but failed to produce significantly greater improvement on manic measures and the response rate in manic subjects. There was a lesser incidence of dizziness and fatigue in the combination therapy compared to CBZ monotherapy.

Researchers concluded that adjunctive FEWP has additive beneficial effects in bipolar patients, particularly for those in depressive phase.

Integrative therapies with good evidence for mental illness include hypnotherapy, hypnosis, music therapy, psychotherapy and yoga. Integrative therapies should not delay the time to diagnosis or treatment with more proven techniques or therapies, and should not be used as the sole approach to illnesses.